Rhabdomyolysis Due to Severe Hypophosphatemia in Diabetic Ketoacidosis.

Rhabdomyolysis is a syndrome characterized by injury to skeletal muscle fibers with disruption and release of toxic metabolites into circulation. It is characterized by triad of muscle weakness, myalgia and dark urine and is associated with increased creatine kinase and lactate dehydrogenase. A severely malnourished 10 year old girl with severe diabetic ketoacidosis as hemr initial presentation of type 1 diabetes mellitus developed rhabdomyolysis (CK- 12,000 U/L) with non-oliguric renal failure during her initial course of hospital stay. The possible cause of her RM was attributed to severe hypophosphatemia (minimum serum phosphate, 0.8 mg/dL). Management of diabetic ketoacidosis phosphate supplementation and urinary alkalinization with diuresis improved her clinical course. She was discharged on Day 9 with Insulin. We recommend frequent monitoring of serum phosphate during early period of DKA, particularly in malnourished children, and its normalization in case of severe hypophosphatemia.

Treatment of mental disorders in India.

1. Mental health gets a low priority all over the world but much more so in developing countries. 2. In India, modern psychiatric facilities are available only in the cities. Mental hospitals are becoming modernized but the backbone of psychiatry is the psychiatric department in the General Hospital where treatment is out-patient and family based except short admissions for crisis intervention. 3. Psychotropic drugs are preferred both by psychiatrists and patients, next being electroconvulsive therapy (ECT) and other physical treatments followed by psychotherapies. 4. In view of paucity of facilities, 80% of the population has to depend on indigenous treatments consisting of Ayurvedic and Unani systems of medicine, religious treatments consisting of prayers, fasting, etc. and various witchcraft and magical rituals.